Assistance exhaustion was linked to lower quality and safety of health care, as well as lower patient satisfaction, according to a new analysis and meta-analysis. The report was published on Tuesday in Open JAMA Network.

The investigators evaluated 85 studies that included data from 288,581 nurses from 32 countries. The average age of the nurses was 33.9 years and 82.7% were female. The study was open to registered nurses, nurse practitioners and nurse supervisors worldwide, in any specialty.

Exhaustion assistant was associated with lower patient safety, more nosocomial infections, patient falls, medication errors, adverse events, as well as lower patient satisfaction ratings and lower nurse-rated quality of care. Associations were consistent regardless of nurses’ age, sex, work experience, and geography.

The average prevalence rate of burnout was 30.7% among the nurses studied.

Although nurse burnout was associated with lower ratings of patient satisfaction, it was not associated with frequency of patient complaints or patient abuse. It was also linked to lower nurse-rated quality of care, but not mortality rate.

“The association of nurse burnout with patient safety was persistent over time, and the association with quality of care was increasingly negative over three decades, even after accounting for the COVID-19 pandemic,” the authors wrote. The team said the finding is concerning because there have been national and organizational initiatives to improve quality for decades.

Efforts to combat burnout have mostly focused on individual interventions, such as personal resilience training and mindfulness, to teach nurses how to cope with stress, but have not focused on how to reduce stress and exhaustion. Many effective interventions are at the work unit level to help workers experience teamwork, a sense of community, professional development, and recognition.

“A number of healthcare organizations have begun to take action, including appointing senior leaders to develop an organizational strategy to address root causes in the clinical practice environment, such as low staffing levels and long working hours or overtime “, the authors wrote.